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Snoring: City couples seeking help

Snoring is not yet a major cause of divorce in India, but city doctors said scores of couples are now seeking help. “This is why we decided to start this dedicated laboratory that will address snoring. It starts off as an irritant but invariably leads to other more serious diseases that could be fatal.

The earlier you seek help, the higher are your chances of a cure,” said Dr Ranjan Das, in-charge of the laboratory at the CMRI Hospital.

After a night-long observation at the clinic, the patient comes to know the source of his problem and how severe it is. “Of the four cases that we have handled so far, three have been classical sleep apnea. It results from a partial collapse of the tissues at the back of the throat. Obesity and prolonged consumption of alcohol are known to loosen the tissues fast and cause snoring. It could also be hereditary in some cases,” added Dr Das.

There is, however, no magic cure. CPAP or a Continuous Positive Airway Pressure instrument is used to regulate the air pressure passing through the throat and cut off the snoring noise. The patient has to use it for a prolonged period, if not life-long.

Still, experts believe it is worth taking the trouble because every time you wake up snoring hard, your cerebral nerves take a pounding apart from leaving your spouse thoroughly disgusted. “The oxygen supply to the brain is cut off by the obstruction and when it reaches a saturation point, the patient is woken up. An average patient goes through this at least 8-10 times every night. It invariably results in a stroke at some stage and even affects the heart,” said preventive medicine specialist Debashish Basu.

Sleep apnea patients are three times more prone to strokes than the rest. In fact, more than fifty of them have even formed a club in Kolkata to help each other overcome the problem.

Snoring-induced sleep deprivation could also be dangerous, experts pointed out. “One of my patients has developed a habit of dozing off while driving. He had several close shaves,” added Basu.

Apart from using the CPAP device, alteration in lifestyle was also necessary, said doctors at the clinic.

“To begin with, one must quit alcohol and smoking, apart from a conscious effort to reduce weight. And don’t be ashamed to admit that you have a snoring problem,” said Das.


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Sleep apnea leads to heart disease

A new study has revealed that people with obstructive sleep apnea (OSA), a sleep disorder associated with obesity, have more non-calcified or “bad” plaque in their coronary arteries.

“Our study reveals that individuals with obstructive sleep apnea are prone to developing an aggressive form of atherosclerosis that puts them at risk for impaired blood flow and cardiovascular events,” said U. Joseph Schoepf, director of cardiovascular imaging at the Medical University of South Carolina in Charleston, S.C.

OSA is caused by obstruction of the upper airway during sleep and is characterized by periodic pauses in breathing, which last for 10 or more seconds. OSA is also commonly associated with snoring.

In the study, 49 obese patients, mean age 61, with OSA and a mean body mass index of 33, and 46 obese patients without the disorder underwent coronary CT angiography (cCTA), which provides detailed pictures and information on plaque buildup and narrowing in the vessels.

The OSA group included 26 men and 23 women, and the matched control group included 22 men and 24 women.

The imaging revealed that the amount of calcified plaque in the coronary arteries was not significantly different between the two groups, but the overall composition of vessel plaque was notably different.

“Compared to the non-OSA group, the patients with OSA had a significantly higher prevalence of non-calcified and mixed plaque,” Schoepf said.

Non-calcified plaque is considered bad plaque, because it is more vulnerable to rupturing and causing a blood clot, which could lead to a heart attack or other cardiovascular event.


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Moitra's death due to sleep apnea?

There is a lot of mystery surrounding the Rahul Mahajan case, especially Vivek Moitra’s death. Our experience in the US with these cases is extensive, no thanks to the nearly universal use of recreational drugs in this country! I wanted to comment on what I think may have happened.

The death of Vivek Moitra may have been related to two things – possibly an opiate (in this case, heroin possibly) overdose, but I think it is more likely due to a pre-existing condition called sleep apnea.

Based on his body habitus and facial characteristics, Moitra had a 90% likelihood of having obstructive sleep apnea – a condition that makes a person vulnerable to the effects of alcohol and other brain depressants, such as sleeping pills and, in this case, possibly heroin or similar drugs.

More than 90% of people with sleep apnea unfortunately do not know they have the illness even in the US, and in India there is such a paucity of awareness about it that I would estimate more than 99% of Indians with sleep apnea are never diagnosed.

Very few even seek medical attention as the symptoms mainly include loud snoring and daytime fatigue which are usually not taken seriously. It often results in hypertension and diabetes mellitus, both conditions I believe Moitra was known to suffer from.

Often we find in these fatal cases that the levels of the toxic substance in the blood – (heroin or similar substances) – are far from lethal.

In fact, sometimes all it may take is just an alcohol binge to be fatal in someone with sleep apnea, and again it is because these people are uniquely predisposed to the brain depression effects of drugs.

The white powder found in his pockets is eerily similar to the cases we see in the US where a kind of a powder – GHB – is found on the victim’s clothing. It needs to be mixed in water or alcohol.

The street name is “G” and its use is spreading rapidly among teens. Standard drug screens may not always include testing for this substance.

Overdoses of GHB is usual in conjunction with alcohol and sometimes occurs in conjunction with Ecstasy (this is another substance which would not be tested for in a “routine” drug screen).

These cases are becoming exceedingly common in teenagers and young adults. There is at least one case of this in most ICUs in the US with a clinical presentation identical to that of Rahul’s – they are usually placed on temporary ventilatory support and are often times out of danger in 24 hours or so.

Fatalities in these cases are usually secondary to pre-existing conditions, such as sleep apnea.


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People with sleep apnea face stroke risk

A new study has warned that persons with serious cases of sleep apnea- which is basically characterized by intense snoring accompanied by prolonged pauses in breathing (more than ten seconds)- have 2.5 times more the possibility of suffering an ischemic stroke.

This was confirmed in a study undertaken among 394 subjects aged 70 or more. “After studying the quality of their sleep, we tracked the volunteers over the course of six years. After which, 20 of the study subjects had suffered a stroke”, Roberto Munoz, a physician of the Neurology Service of the Hospital Complex of Navarra.

Furthermore, he confirmed that in addition to the fact that sleep apnea affects above all persons of middle and advanced age—it is estimated that 5 per cent of all adults suffer from it—this prevalence may significantly increase with age.

Among the predisposing factors for suffering this disorder, the expert emphasized obesity. “Therefore, one of the measures for avoiding the problem is losing weight.”

“It is also a good idea to avoid sleeping face-upwards—since this position aids in the appearance of snoring—as well as quitting tobacco use and the excessive consumption of alcohol,” adds Munoz. In the most serious cases, the treatment includes the nightly use of a pressurized air mask, although he emphasized that each patient should receive the treatment most appropriate for his or her case.

“Over the long term, in addition, the alterations in respiration can result in hypertension, cardiovascular problems, and finally in stroke; hence the importance of preventing it and treating it from its outset,” concluded the expert.

The research was presented at the School of Medicine and the University of Navarra Hospital.

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Sleep Apnea Risks In Pregnant Women

Sleep apnea is probably one of the last thing on an expecting woman’s mind. However, even in women who are non-pregnant, sleep apnea and other sleep disorders run rampant and often go undiagnosed and untreated for years. Sleep disorders are very prevalent in women due to continuously fluctuating hormones each month. In pregnant women, the vulnerability of suffering from a sleep disorders such as sleep apnea increases.

In non-expecting women, a study conducted by the National Sleep Foundation discovered that 3 out of 4 women said that while pregnant, the amount of sleep disruptions were much greater when compared to the number of disruptions that occurred pre-pregnancy. The women reported most commonly of difficulty falling asleep and staying asleep as well as frequent wakening and a decrease in sleep quality. Combined, these problems are known to cause fatigue and a lack of energy. At the same time, all of these conditions are also known symptoms of sleep apnea. In pregnant women the risk of sleep apnea is great.

Pregnancy And Sleep Apnea Risks

Though no one wants to worry more than they need to, when a woman is pregnant, her health is most important to ensure that the term of the pregnancy is normal and that the health of the mom and the baby are at optimal levels. However, when pregnant, women experience a rapid increase in body weight along with hormone levels that change very frequently. Both of these unavoidable factors can cause a woman to suffer from sleep apnea which often decreases the amount of oxygen in the blood and in the lungs which then causes the heart to work harder than usual. The risks are even higher in pregnant women who were overweight before becoming expectant mothers.

In the case of pregnant women suffering from sleep apnea, treatment is twice as important as two lives are at risk. Women should take special care when it comes to treating sleep apnea because when left untreated the condition can lead to hypertension, preeclampsia, and low birth weight.

At the same time everyone should remember that sleep apnea does not discriminate and can be diagnosed in anyone of any age or gender at any time. While pregnant women may be at a higher risk, non-pregnant women, men, and even children too can be diagnosed with sleep apnea. However when sleep apnea is diagnosed in a pregnant woman, treatment becomes a necessity for not only her health but her unborn child’s health as well.

If you have been suffering from common symptoms of sleep apnea including constant snoring, daytime fatigue, restlessness, and morning headaches, now is the time to consult with a sleep physician in order to be properly tested and diagnosed. After a positive diagnosis you will want to seek help regarding sleep apnea treatment. Dr. Weiser works with patients of all types, especially patients who are looking to avoid using CPAP technology. Contact our office today to learn about the sleep apnea treatments available.


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CPAP Treatment for Sleep Apnea Fights Fatigue

A common treatment for obstructive sleep apnea(OSA) may have the added benefits of fighting fatigue and increasing energy as well as helping people sleep better.

A new study shows that use of continuous positive airway pressure (CPAP) decreased fatigue and increased energy in people with the sleep-related breathing disorder after only a few weeks of treatment.

Obstructive sleep apnea is a common sleep disorder that occurs when a person has pauses in their breathing because of obstruction of airflow. For example, when muscles relax during sleep it can cause soft tissue in the back of the throat to collapse and temporarily block the upper airway.

Obstructive sleep apnea is usually associated with loud snoring and less restful sleep. As a result, daytime sleepiness, fatigue, and lack of energy are frequent complaints among people with OSA.

Researchers say the treatment of choice for obstructive sleep apnea is CPAP, which involves wearing a mask that delivers a forceful stream of air during sleep. CPAP has been shown to increase oxygen flow during sleep, reduce the frequency of airway blockages, and decrease daytime sleepiness.

CPAP: Fatigue Fighter

In the study, published in Sleep, researchers looked at the effects of treatment with CPAP or a dummy treatment in 59 adults with obstructive sleep apnea on self-reported measures of fatigue and energy.

The results showed CPAP significantly reduced the average fatigue score from 8.8 on a scale of one to 10 — with 10 being highly fatigued —  to -0.1 after three weeks of treatment. Energy levels also increased significantly in the real CPAP group compared to the dummy treatment group.

“These results are important, as they highlight that patients who comply with CPAP therapy can find relief from fatigue and experience increases in energy and vigor after a relatively short treatment period,” researcher Lianne Tomfohr, graduate research assistant in the joint doctoral program at San Diego State University and the University of California, San Diego, says in a news release.

Researchers say CPAP was especially beneficial in increasing energy and reducing fatigue in people who reported excessive levels of fatigue or sleepiness before treatment.


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Snoring has high socio-economic costs

Danish researchers say the high socio-economic costs of sleep disorders rise when disorders go untreated.

Sleep researchers at the University of Copenhagen and the Danish Institute for Health Services Research say sleep disorders — including snoring violently, sleep apnea, narcolepsy and obesity-related breathing difficulties — cause people to use health services more frequently, take more medicine and endure more frequent unemployment.

The study linked undiagnosed and untreated sleep disorders to increased intake of medication, a higher rate of hospital admissions and 30 percent more unemployment.

“The economic costs to society can be quite considerable,” study investigator Poul Jennum said in a statement. “That’s why it is essential that people with the disorder have access to a system of treatment — otherwise the illness can affect their education, ability to work and thus their economic circumstances and health.”

The study, published in Acta Neurological Scandinavia, found sleep disorder patients received state benefits more often than healthy subjects, had lower incomes and more absences from work.

The more serious the sleep disorder, the higher the socio-economic cost, the study concludes.


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Why Can't I Sleep?

et eight hours of shut-eye a night. Drink milk before bedtime to fall asleep faster. Mom’s advice not working for you? If you’re still wondering, Why can’t I sleep?, separate fact from fiction with these 10 common sleep myths…

Spending another night tossing and turning in bed? So are 40 million Americans.

The American Academy of Sleep Medicine reports that 30% of adults have insomnia, most of them women. It’s no wonder that sleeping aids are a $20-billion industry and that Ambien is one of the top five prescriptions written in the U.S.

Sleep is as important to your health as eating right and exercising. It helps repair, refuel and refresh the body and mind.

But before you lose precious sleep over not getting enough shut-eye, find out how much you really need or if a scotch or sleeping pill is better to get you to Snoozeville. Here’s the truth behind 10 common sleep myths:

1. Everyone needs at least eight hours of sleep a night.

False! Eight is not the magic number. Some women thrive on only seven hours; others need more to feel refreshed, according the National Sleep Foundation, a nonprofit that promotes better sleep.

In fact, studies show that those who sleep seven hours may live longer than those getting eight or more hours, says Gregg D. Jacobs, M.D., an insomnia specialist at the Sleep Disorders Center at the University of Massachusetts and author of Say Goodnight to Insomnia (Holt Paperbacks).

Too much sleep is linked to chronic conditions such as obesity and diabetes, he says.

If you’re snoozing 12 or more hours a day, talk to your doctor. You could have depression orchronic fatigue syndrome.

The average woman gets about 6.5 hours a night, says Donnica Moore, M.D., president of the Sapphire Women’s Health Group and a consultant for the National Sleep Foundation. And they’re “walking around with a chronic sleep deficit.”

What about people like Martha Stewart and former President Bill Clinton, who seem to thrive with only four hours? Research from the University of Utah points to a genetic variation as an explanation.

So how do you know if you’re getting enough zzz’s? Are you irritable during the day? Do you feel sad or have mood swings? Trouble concentrating? They’re signs of sleep deprivation.

2. More women suffer from insomnia than men.

True! Women are twice as likely to have insomnia as men, according to statistics from the U.S. Department of Health and Human Services.

Why? Blame life and women’s bodies.

Menstrual cycles, menopause, hormones, age, stress, work, health, mood, parenthood, even being single, can disturb sleep.

A June 2009 University of Pittsburgh study of 360 middle-age women found those in stable marriages slept better than singles. Sleep was most elusive for those who had recently lost a partner. Not surprisingly, newlyweds reported restless slumber.

And as any bleary-eyed new mom knows, motherhood also makes women lose snooze time. A study in the July 1 issue of the journal Sleep suggests that postpartum depression may aggravate already impaired sleep.

3. A good stiff drink will give you a good night’s sleep.

False! Put away the shot glass. At first, that hot toddy will make you feel drowsy and calm, but you’ll pay for it later.

It’ll increase the number of times you wake up during the night, Moore says.

Alcohol also can make snoring louder and exacerbate obstructive sleep apnea, Jacobs says.


And never use it if you’re taking a sleeping pill. Popping Ambien after a few glasses of wine, for example, can lead to blackouts, memory loss and erratic behavior.

“Two plus two isn’t four – it’s more like 10,” says Neil Capretto, D.O., medical director of Gateway Rehabilitation Center in Pittsburgh, PA. “You’re pushing your nervous system in different directions at the same time.”

4. You can get hooked on sleeping pills.

True! Sleeping pills — particularly newer non-benzodiazepine hypnotics — are safe for a few days to help you get over such sleep-depriving situations as a breakup or job loss, or to “break the cycle of insomnia,” Jacobs says.

But don’t use them longer than a month, he warns.

People can “become more psychologically dependent on them,” he says, and “in high enough doses… physically dependent.”

They also have side effects, such as daytime drowsiness, memory loss and can impair driving.

Adopting better sleep habits is a far better approach to curing insomnia, but “good habits require more energy than medications do,” Schulman says.

Jacobs recommends cognitive behavior therapy to learn how to relax and sleep.

5. Napping means you’re sick or lazy.

False! Many of us feel a mid-afternoon slump, but don’t blame the double-cheeseburger you had for lunch. It occurs because we’re meant to have a nap, Jacobs says.

Daytime catnaps of about 45 minutes can improve your mood and memory, according to a 2008 Harvard Medical School study published in the journal Sleep.

If you’ve slept badly the night before, a siesta will help restore your energy and alertness, Jacobs says.

They’re more effective when they’re part of your daily routine, Moore says.

But watch out: Don’t take one after 4 p.m. because it may disrupt your night’s rest. And some people get “sleep inertia,” a temporary grogginess or confusion when awakening from a nap.

6. If you have trouble sleeping, watching TV, working on your laptop or reading in bed will make you sleepy.

False! If you use your bed as a workstation, you’re asking for trouble.

That’s because you’ll associate your bedroom as a place to be active, not to relax and leave the day behind.

“Your bed should be only for sleep and sex,” Schulman says.

What if you’re tossing and turning? Get out of bed after 30 minutes, Jacobs advises. Distract yourself with an activity in another room and then try sleeping again.

“This allows the brain to relax and lets you fall asleep more quickly,” he says.

Also, when you turn in, turn down the thermostat: It’ll help you sleep soundly, Schulman says.

7. If I lose sleep during the week, I can make it up on the weekend.

False! It’s a common but useless strategy, because once you lose sleep, it’s gone.

“You can’t make that up on the weekends, holidays or vacations,” Moore says.If you suffer from insomnia, sleeping in on weekends is like hopping a plane from New York to Los Angeles.

“You’re creating the equivalent of jet lag because you’re disrupting your sleeping cycles — just as if you were taking a trip across country every week,” Jacobs says. “It’s better to establish a consistent sleep rhythm.”

And don’t worry about occasional sleeplessness, he says. It usually goes away on its own.

In fact, getting anxious about not sleeping is worse than losing it, he says. That sets up “a cycle of stress that will disturb sleep.”

8. Sleep can help you lose weight.

True! Sleepless people pack on the pounds, Moore says.

Scientists don’t know why but suspect lower levels of appetite-controlling hormones, such as leptin and ghrelin, may play a role. Or maybe we tend to gobble more food when we’re tired.

Many women work frantically until 10 p.m., and then, after the kids and husband are snoozing, they scarf up everything in the kitchen, Moore says. “If you’re tired, you need to go to bed – not eat.”

9. If I sleep on a problem, the answer will be clear in the morning.

True! You may think your brain is working on solving problems as you sleep, but actually answers come because you’re more refreshed and can concentrate better in the morning, Schulman says.

Some researchers think the Rapid Eye Movement (REM) sleep stage may help our brains sort out, process and consolidate information and memories.

“There’s something to letting your subconscious work it out and letting the answer come to you,” Moore says. “Anytime you have to do problem solving or deal with any stressful situation, you are better off if you are well rested.”

10. A warm glass of milk will help you sleep.

True! Who can argue with Mom?

But it may not be the warm milk.

Although it has the amino acid tryptophan, which the body converts to the sleep-inducing hormones melatonin and serotonin, it’s not enough to bring in Mr. Sandman. It’s a psychological association – the ritual of heating the drink and pouring it into a favorite cup – that makes your eyelids feel heavy, Moore says.

Contact us at Omnisleep to help us help you sleep better.

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Apnea May Be Cause for Nocturia

A new study finds that a significant number of patients with benign prostate enlargement (BPE) may have obstructive sleep apnea (OSA), which may be the reason for their night awakenings and urination. The study’s findings have been published in the Journal of the American Board of Family Medicine.

The researchers, from Ben-Gurion University of the Negev (BGU), Israel, compared men between the ages of 55 and 75 who were randomly sampled from primary clinics, diagnosed with BPE, and reported nocturia (or waking during the night to void) at least once nightly. The comparison group had no BPE and one or no nocturia episodes per night. Nocturia is a common BPE symptom.

The researchers found that more than half (57.8%) of patients with enlarged prostates may in fact have the sleep disorder, and that the awakenings that patients ascribed to their need to urinate at night may be actually caused by their sleep disorders.

“If nocturia severity in BPE patients is actually a preexisting sleep disorder, this can now be treated and help improve patients’ quality of life,” says Howard Tandeter, MD, study coauthor and researcher in the family medicine department at BGU. He recommends that physicians treating patients with BPE, who report frequent awakenings from sleep to urinate, consider OSA as a possible cause and treat accordingly.

“Even among those patients with well-defined medical reasons for nocturia, sleep disorders may still be found as the source of most awakenings from sleep. Therefore, the diagnosis of a sleep disorder should be seriously considered whenever a patient reports frequent awakenings from sleep to urinate since the problem is treatable,” adds Tandeter.


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Why Sleep Apnea Raises Risk of Stroke, Heart Attack

Loud snoring can be a problem — and not just for other people trying to sleep with the noise. It can also be a sign of sleep apnea. People with this condition repeatedly stop breathing while they sleep, and may not even know it.

Doctor David Gross is a lung specialist at the National Rehabilitation Hospital of Washington.

DAVIS GROSS: “Sleep apnea means that the airway, the upper airway, cuts off at night. So the person, while he’s breathing normally in the daytime, when he goes to sleep, the muscles get all relaxed and cut off and this can happen over and over again, sixty to one hundred times an hour.”

Most people who snore do not have sleep apnea. But doctors say most people with sleep apnea do snore. Sleep apnea not only reduces sleep quality and makes people feel tired during the day. More and more studies show that it can also lead to strokes and heart attacks.

Dr. Michael Twery of the National Institutes of Health explains why.

MICHAEL TWERY: “Whenever we run out of enough air to breathe, it sends alerting signals to our minds. It raises the level of stress hormones. It tells our heart to work harder.”

When a person stops breathing, oxygen levels in the blood decrease. This happens again and again with sleep apnea.

MICHAEL TWERY: “And it’s constantly exposing us, night after night, to periods of insufficient oxygen. The level of oxygen in our blood will actually decrease to levels that would be considered a medical emergency.”

Dr. Twery compares the effect of sleep apnea to racing a car engine for long periods of time.

MICHAEL TWERY: “Our heart becomes overworked and we become more vulnerable to heart attack.”

And also strokes. Dr. Twery led a study of about nine thousand people who had sleep apnea but no history of heart disease. The researchers followed their progress for nine years.

MICHAEL TWERY: “They found that men can experience up to a three-fold increased risk of stroke, and that risk seemed to be well correlated with the severity of sleep apnea.”

In other words, the more severe the sleep apnea, the greater the chance of a stroke.

The next step will involve sleep apnea patients who have already had a stroke or heart attack. Researchers will study whether patients can reduce the risk of a second one with a machine called a CPAP. CPAP is continuous positive airway pressure. It provides a continuous flow of air into the throat and lungs while the person sleeps.

Sleep apnea seems to be more common in men than in women, and it becomes more common as people get older. The most common form is called obstructive sleep apnea. People who have it are often overweight or have it in their family, but it can affect anyone. In children, for example, enlarged tonsils in the throat can interfere with breathing as they sleep.


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